tag:theconversation.com,2011:/au/topics/alcohol-use-40936/articlesAlcohol use – The Conversation2018-03-13T10:40:14Ztag:theconversation.com,2011:article/900382018-03-13T10:40:14Z2018-03-13T10:40:14ZBooze and basketball: Why binge drinking increases during March Madness<figure><img src="https://images.theconversation.com/files/208958/original/file-20180305-146700-p1hb9a.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">North Carolina fans react while watching the Tar Heels play in the 2009 Final Four.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/NCAA-Championship-NCarolina-Fans-Basketball/173628c8d88142b0a023f1ca28f0fa50/3/0">Gerry Broome/AP</a></span></figcaption></figure><p>For every tip-off during March Madness, it’s a sure bet that students at the schools playing in the basketball tournament will be tipping up more beer bottles than usual. </p>
<p>This was one of the key findings of an <a href="http://www.nber.org/papers/w23821">analysis</a> we conducted recently on the impact of the NCAA men’s basketball tournament on college students’ drinking behavior.</p>
<p><a href="https://scholar.google.com/citations?user=v4lUXq4AAAAJ&amp;hl=en">We</a> are all <a href="https://scholar.google.com/citations?user=FUl4oMsAAAAJ&amp;hl=en">economists</a> with a keen interest in the relationship between <a href="https://scholar.google.com/citations?user=TdNR3AIAAAAJ&amp;hl=en">health and economics</a>. Our recent study shines light on the well-established fact that alcohol consumption – and the negative effects that come along with it – often goes hand in hand with college sports. For that reason, college sporting events represent prime opportunities to think about ways to curtail drinking among college students.</p>
<h2>A long-standing tradition</h2>
<p>Researchers have long known that alcohol consumption rises during college sporting events. <a href="https://www.tandfonline.com/doi/full/10.1080/07448480903540473">Study</a> after <a href="https://www.tandfonline.com/doi/abs/10.3200/JACH.56.3.255-260">study</a> has found that college students were more likely to binge drink on football game days.</p>
<p>The same is true for college basketball. For instance, a <a href="http://www.jsad.com/doi/abs/10.15288/jsa.2005.66.291">study</a> of 206 undergraduate students at Syracuse University in 2003 – when Syracuse won the NCAA men’s basketball championship – found that alcohol consumption on the two game days of the championship exceeded what is typical on campus.</p>
<h2>Negative effects</h2>
<p>Binge drinking is associated with many harmful outcomes for the drinker and those around them. These outcomes include <a href="http://pediatrics.aappublications.org/content/119/1/76">lower grades and increased rates of drunk driving</a> and <a href="https://www.aeaweb.org/articles?id=10.1257/app.20160031">sexual assault</a>. One <a href="http://journals.sagepub.com/doi/abs/10.1177/1527002508327389">study</a> found that assaults, vandalism and arrests for disorderly conduct and alcohol-related offenses increased on college football game days in the towns that hosted the game, especially after upsets.</p>
<p>What is it about college sports that seems to lead to increased rates of drinking? The first thing to understand is that college students binge drink and report heavy alcohol use at <a href="https://www.collegedrinkingprevention.gov/statistics/prevalence.aspx">higher rates</a> than their peers who aren’t in college. Social norms likely play a large role in this fact. For instance, <a href="https://search.proquest.com/docview/1437931285?accountid=14692">one study</a> found that college students tend to think that their peers drink more than they actually do. This perception can cause individuals to believe that heavy drinking is the norm, not the exception.</p>
<p>A different <a href="https://www.collegedrinkingprevention.gov/media/journal/164-perkins2.pdf">study</a> found that alcohol consumption can be reduced among college students by providing them with accurate information about how often their peers drink.</p>
<h2>The role of high-stakes games</h2>
<p>In order to understand how a major college sporting event affects alcohol consumption across different colleges, we examined the effect of the NCAA men’s basketball tournament on college students’ reported alcohol use.</p>
<p>We relied on the Harvard School of Public Health <a href="http://archive.sph.harvard.edu/cas/About/index.html">College Alcohol Study</a>, which provides information on students’ alcohol consumption at 43 NCAA Division I institutions in 1993, 1997, 1999 and 2001. With this data, we compared drinking rates before, during and after the tournament as well as across tournament and non-tournament schools each season.</p>
<p>We found that nearly 60 percent of male students whose school had just played in the men’s basketball tournament reported binge drinking once more in the past two weeks than a male student whose school did not play a tournament game during the survey window.</p>
<p>Overall drinks consumed experience a similar jump, as male students at tournament schools reported drinking 6.9 additional alcoholic beverages on average during the tournament. These numbers are comparable with <a href="http://www.tandfonline.com/doi/full/10.1080/07448480903540473">elevated drinking estimates</a> associated with college football game days.</p>
<h2>White males affected most</h2>
<p>The increase in binge drinking appears to be concentrated mostly among white male students. While 60 percent of male students binge drink more when their team plays in the NCAA Tournament, we detect no increase in alcohol consumption among female students. </p>
<p>According to our study, approximately 1 in 3 students who are over 21 appear to binge drink more when their team plays in the NCAA tournament. One in 4 underage students report binge drinking once more when their team plays.</p>
<p>The College Alcohol Study asked respondents about drinking and driving, so we were able to observe that students not only reported drinking more during the NCAA tournament, but that they were also about 10 percent more likely to report driving under the influence of alcohol or riding with someone who is under the influence.</p>
<p>Our paper adds to the growing amount of evidence that alcohol consumption during college sporting events has harmful effects on society. While we do not know of any single solution for all students at all schools, we note that <a href="https://www.tandfonline.com/doi/abs/10.1080/07448480109596011">reducing the availability of alcohol at sporting events</a> has the ability to reduce “arrests, assaults, ejections from the stadium, and student referrals to the judicial affairs office.”</p>
<p>The <a href="https://www.nih.gov/">National Institutes of Health</a> has also created resources for both <a href="https://www.collegedrinkingprevention.gov/media/NIAAA_BacktoCollege_Fact_Sheet.pdf">parents of college students</a> and for <a href="https://www.collegedrinkingprevention.gov/CollegeAIM/Default.aspx">college administrators</a> to help reduce the amount of dangerous alcohol consumption among college students.</p><img src="https://counter.theconversation.com/content/90038/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Binge drinking rises during March Madness among male college students who attend schools that made it to the men's basketball tournament. Researchers take a deeper look at the reasons why.Dustin R. White, Assistant Professor of Economics, Business Administration, University of Nebraska OmahaBenjamin Cowan, Associate Professor of Economics, Washington State UniversityJadrian Wooten, Assistant Teaching Professor of Economics, Pennsylvania State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/833032017-09-11T19:41:55Z2017-09-11T19:41:55ZAustralian teens doing well, but some still at high risk of suicide and self-harm<figure><img src="https://images.theconversation.com/files/185205/original/file-20170908-9563-1yvye7k.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Teens most at risk of self-harm are those who are same-sex attracted or bisexual, or those with depression, anxiety or general feelings of unhappiness.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Following a large group of people over a long time is a terrific way to learn more about life in Australia. The Growing Up in Australia: <a href="https://aifs.gov.au/projects/growing-australia-longitudinal-study-australian-children">Longitudinal Study of Australian Children</a> (LSAC) has been going since 2004, following the lives of thousands of children into adulthood and gathering data from parents, teachers, carers and the children themselves. </p>
<p>The latest <a href="https://aifs.gov.au/publications/longitudinal-study-australian-children-annual-statistical-report-2016-0">LSAC Annual Statistical Report</a> provides a window into how the lives of Australian teenagers are changing.</p>
<h2>Many have tried alcohol, but few drink regularly</h2>
<p>Just over 40% of teens reported having had a few sips of alcohol by the age of 15, but only 16% had consumed a full serve. Of those who had tried alcohol, 28% of boys and 15% of girls had done so before the age of 13. </p>
<p>This doesn’t mean that young teenagers who have tried alcohol are necessarily drinking to excess, just that they are sampling alcohol at a relatively young age. For most 14- and 15-year-olds, drinking alcohol was not a regular practice — only 7% had consumed an alcoholic drink in the month before their interview. </p>
<p>Parents’ regular, short-term, <a href="http://www.growingupinaustralia.gov.au/pubs/asr/2016/asr2016d.html">risky drinking</a> was shown to be a strong factor in influencing their teenage children to try alcohol. Around 11% of mothers and 30% of fathers reported having at least five drinks on a single occasion at least twice a month. </p>
<p>Most parents did not drink daily; of those who did, more men than women exceeded guidelines for long-term risk. </p>
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<span class="caption">Percentage of parents (of 12–to-13-year-olds) who drink at risky levels.</span>
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<p>Friends also had a strong influence. Almost 40% of those who had at least one friend who drank alcohol had tried alcohol themselves, compared to only 5% of those who had no friends who drank. </p>
<p>Teens were also more likely to have tried alcohol if they were the only child, in the later stages of puberty, or in a single-parent household. But even after accounting for all these factors, there was still a significant association between parents’ drinking habits and adolescents’ alcohol use. Those whose parents drank at a risky level were most likely to have tried alcohol. </p>
<h2>Rates of self-harm and suicidal behaviour are high</h2>
<p>One in ten 14-to–15-year-olds had <a href="http://www.growingupinaustralia.gov.au/pubs/asr/2016/asr2016f.html">self-harmed</a> in the previous 12 months, and 5% had attempted suicide. </p>
<p>Girls appeared to be at greater risk than boys of both self-harm and suicidal behaviour. However, boys were much more likely to act impulsively and make an unplanned suicide attempt.</p>
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<p>Some teens are more at risk of self-harm than others. Those who were same-sex attracted, bisexual or unsure of their sexuality were at greater risk of self-harm than heterosexual teens.</p>
<p>The risk of self-harm was also higher among teens with more reactive temperaments, depression, anxiety or general feelings of unhappiness and those who reported being threatened or feeling victimised by their peers because of their health, skin colour, sexual orientation, language, culture or religion. </p>
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<p>Self-harm can often act as a “gateway” to suicide. Of those who had attempted suicide, two-thirds had previously self-harmed. </p>
<p>Teens were at higher risk of suicide if they were same-sex attracted, bisexual, or unsure of their sexuality; or if they had been involved in so-called “delinquent behaviour” such as crime or property offences. Of those who attempted suicide, 22% had done so more than once and 14% of boys and 18% of girls had required medical treatment after a suicide attempt. </p>
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<h2>Teens employed in part-time jobs</h2>
<p>At 15, almost 40% of young people had <a href="http://www.growingupinaustralia.gov.au/pubs/asr/2016/asr2016c.html">worked in a part-time job</a>. Of those working, around one-third worked informally in a family business or for themselves. Most worked during the school term, with 18% of boys and 25% of girls working on weekdays. </p>
<p>Compared with teens living in the city, those in regional areas were more likely to be employed. </p>
<p>And while girls were more likely to be employed than boys, in regional areas a higher percentage of boys were working. This might reflect the types of informal work available regionally, such as farming and labouring work. </p>
<h2>Young carers falling behind at school</h2>
<p>At least one in ten 14–to-15-year-olds were <a href="http://www.growingupinaustralia.gov.au/pubs/asr/2016/asr2016e.html">providing informal care</a> for a household member, with around two-thirds of this group helping with core activities including personal care, mobility and communication.</p>
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<span class="caption">Average Year 9 NAPLAN scores, by carer status.</span>
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<p>On average, young carers have lower performance levels in NAPLAN reading and numeracy than their non-caring peers. Young carers who provided daily care were more than a year behind their classmates.</p>
<h2>Teens at risk need extra help</h2>
<p>While most teens are doing well, some teens would benefit from extra help. Parents, teachers and friends of young people need support and advice to know how to help those at risk.</p>
<p>Programs to assist young carers to participate fully in school would be of considerable long-term benefit. Increasing awareness of risk factors for self-destructive behaviour in young people could potentially reduce this disability burden.</p><img src="https://counter.theconversation.com/content/83303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diana Warren does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.</span></em></p><p class="fine-print"><em><span>LSAC is conducted as a partnership between the Department of Social Services (DSS), the Australian Institute of Family Studies (AIFS) and the Australian Bureau of Statistics (ABS). DSS provides overall management of LSAC on behalf of the Australian Government; AIFS is responsible for the design and content of the study, data release and for the preparation of research and statistical reports; and ABS is responsible for data collection and delivery, instrument development and management of the LSAC sample. Galina Daraganova does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.</span></em></p><p class="fine-print"><em><span>Jennifer A. Baxter does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A snapshot of Australian teens shows most doing well, but as a group they are still plagued by suicide risk, self-harm and mental health problems.Diana Warren, Research Fellow, Australian Institute of Family StudiesGalina Daraganova, Executive Manager, Longitudinal Studies, Australian Institute of Family StudiesJennifer A. Baxter, Senior research fellow, Australian Institute of Family StudiesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/827532017-08-23T05:39:44Z2017-08-23T05:39:44ZBeer, bongs and baby boomers: the unlikely tale of drug and alcohol use in the over 50s<figure><img src="https://images.theconversation.com/files/183066/original/file-20170822-13660-1p7ity1.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Baby boomers who drink and take drugs risk a range of physical and mental problems that younger substance users don&#39;t necessarily face.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/496022509?src=J4JwkXDIzM9va_WIHJgxBQ-2-62&amp;size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>If you ask someone what a typical heavy drinker or drug user looks like, they’re probably more likely to evoke images of Gen Ys with tattoos and piercings than greying baby boomers. </p>
<p>But recent Australian data, outlined in our <a href="http://www.bmj.com/content/358/bmj.j3885">British Medical Journal editorial today</a>, shows rates of alcohol and drug use are actually decreasing among younger age groups, while increasing dramatically in people over the age of 50.</p>
<p>Not only is there a rise in the proportion of older people who regularly drink at risky levels, there are also more older people using cannabis.</p>
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<em>
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Read more:
<a href="http://theconversation.com/maybe-moderate-drinking-isnt-so-good-for-you-after-all-72266">Maybe moderate drinking isn't so good for you after all</a>
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<p>So, it’s not surprising Australia’s <a href="https://www.hcasa.asn.au/documents/555-national-drug-strategy-2017-2026/file">recently released National Drug Strategy 2017-2026</a> identifies older people as a priority group for attention.</p>
<p>The data has implications not only for the health of the over 50s, but also for health professionals that diagnose and manage substance use or misuse, and the complications that can arise from it.</p>
<p>Evidence shows we can no longer view drug and alcohol issues purely as a young person’s concern.</p>
<h2>Why is alcohol and drug use rising in older Australians?</h2>
<p>Low birth rates and extended life expectancy have resulted in large increases in the <a href="https://aifs.gov.au/facts-and-figures/ageing-australia">proportion of older Australians</a> and higher absolute numbers of older people who drink and use drugs.</p>
<p>For example, the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">one in four 50-59 year-olds</a> drinking at risky levels (five or more standard drinks in a single session) corresponds to <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Sep%202016?OpenDocument">about 755,394</a> people.</p>
<p>Baby boomers (born between 1946 and 1964) have <a href="http://www.bmj.com/content/343/bmj.d6761">higher rates</a> of alcohol and drug use than earlier cohorts of older Australians and many continue this use into their older years.</p>
<p><a href="http://nceta.flinders.edu.au/files/3514/1679/0404/EN557.pdf">Improvements in health care and treatments for substance use</a> mean more people survive into old age, drinking and taking drugs for longer.</p>
<p>Older Australians today also have more disposable income than in previous generations, making access to alcohol and drugs <a href="http://www.scielosp.org/scielo.php?script=sci_arttext&amp;pid=S0021-25712012000300004">more affordable</a>.</p>
<h2>What does the evidence say?</h2>
<p>Our research, using data from the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/about-ndshs/">National Drug Strategy Household Survey</a>, shows high-risk drinking (11 or more standard drinks on a single occasion) in the over 50s increased significantly between 2004 and 2013. People living in regional or remote areas or who smoke tobacco were more likely to drink this way.</p>
<p>The <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">newly released 2016 data</a> indicates this upward trend is continuing even more strongly.</p>
<p><a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">In 2016</a>, 11.9% of 50-59 year olds drank at high-risk levels at least yearly (up from 9.1% in 2013). A total of 5.8% did so at least monthly (up from 4.1%).</p>
<p>Cannabis use among the over 50s <a href="http://onlinelibrary.wiley.com/doi/10.1111/ajag.12357/abstract">more than doubled</a> between 2004 and 2013, from 1.5% to 3.6%. Unmarried men who smoked, drank alcohol, and used other drugs were particularly likely to use cannabis.</p>
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Read more:
<a href="http://theconversation.com/remind-me-again-how-does-cannabis-affect-the-brain-40641">Remind me again, how does cannabis affect the brain?</a>
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<p>There is little reliable data on other illicit drug use in older people. But our data shows older people are using more pharmaceuticals, like <a href="http://onlinelibrary.wiley.com/doi/10.1002/pds.1899/abstract">sedatives</a> and <a href="https://www.mja.com.au/journal/2011/195/5/prescription-opioid-analgesics-and-related-harms-australia">opioids</a>, than before.</p>
<p>And <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/data/">in 2016</a>, 4.1% of 50-59 year olds and 4.5% of people 60 and over used pharmaceutical drugs for non-medical purposes.</p>
<p>Older people often use pharmaceuticals to treat pain (both physical and emotional) or sleep problems. This can also result in balance problems, falls/injuries, reduced ability to function, and even death.</p>
<p>You can find out more about the prevalence of substance use among older Australians in the <a href="http://nadk.flinders.edu.au/">National Alcohol and Drug Knowledgebase</a>.</p>
<h2>Why is all this concerning?</h2>
<p>Growing use of alcohol, cannabis, and prescription drug misuse among older Australians is concerning for a number of reasons.</p>
<p>Older people are more sensitive to the toxic effects of substances such as alcohol. This is because ageing <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">reduces the body’s capacity</a> to metabolise, distribute, and excrete alcohol and drugs.</p>
<p>Older people are also more likely to have <a href="http://nceta.flinders.edu.au/files/3514/1679/0404/EN557.pdf">existing physical or psychological conditions</a>, or to take medicines that may <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">interact</a> with alcohol and drugs.</p>
<p>So older people who use alcohol and/or drugs may be more <a href="http://nceta.flinders.edu.au/files/4114/2249/7473/RCP_2011.pdf">likely to have</a>: falls and other injuries, diabetes and cardiovascular disease, mental health problems (including suicide), obesity, liver disease, <a href="https://pdfs.semanticscholar.org/b8ed/eefa7da25bb2656bc0335cc6768d62b9f039.pdf">early-onset dementia and other brain injury</a>, sleep disorders, and blood borne diseases.</p>
<h2>Not all older people have problems with drugs and alcohol</h2>
<p>Not all older people who use alcohol and/or drugs have problems. Older people, like other age groups, use alcohol or drugs in many different ways and for many different reasons, as we show with this “<a href="http://nceta.flinders.edu.au/files/7014/1679/1083/EN559.pdf">typology of older users</a>”:</p>
<ul>
<li><p><strong>maintainers</strong> continue with their previously unproblematic use as they get older. But age-related changes (like those already outlined) result in increased harms later in life</p></li>
<li><p><strong>survivors</strong> begin using alcohol/drugs early in life. They have a long history of substance use problems that persist into older age and this often results in other physical and/or mental health problems</p></li>
<li><p><strong>reactors</strong> begin using alcohol/drugs in their 50s or 60s, often due to <a href="http://au.wiley.com/WileyCDA/WileyTitle/productCd-1118993772.html">stressful events</a>, like grief, retirement, marital breakdown, social isolation (<a href="http://press.psprings.co.uk/bmj/august/substancemisuse.pdf">particularly older women</a>), or due to pain.</p></li>
</ul>
<h2>Do treatments work for older people?</h2>
<p>The good news is, research shows substance use treatment is <a href="http://nceta.flinders.edu.au/files/9814/2250/4969/Hunter_2010.pdf">just as effective</a> for older people as it is for younger age groups. </p>
<p>Treatment programs adapted specifically for older people have <a href="http://www.sciencedirect.com/science/article/pii/S1878764915001394">even better outcomes</a>.</p>
<p>This is important, as the number of older people who require treatment for alcohol or drug problems is increasing substantially, <a href="http://press.psprings.co.uk/bmj/august/substancemisuse.pdf">both in Australia</a> <a href="http://www.tandfonline.com/doi/abs/10.1080/13607863.2013.793653?tab=permissions&amp;scroll=top">and</a> <a href="https://academic.oup.com/ije/article/43/2/304/675582/Substance-use-disorders-and-psychiatric">overseas</a>.</p>
<h2>Not everyone gets treatment</h2>
<p>Unfortunately, there are <a href="http://nceta.flinders.edu.au/files/1314/1679/1662/EN561.pdf">barriers</a> that can <a href="http://alcoholresearchuk.org/downloads/finalReports/FinalReport_0085">make it harder</a> for older Australians to access treatment or support.</p>
<p>Health-care practitioners and family members may:</p>
<ul>
<li><p>be reluctant to ask older people “embarrassing” questions about substance use</p></li>
<li><p>not know alcohol/drug use is common in older people, or how to address it</p></li>
<li><p>incorrectly attribute symptoms of problem substance use to “just getting older”</p></li>
<li><p>incorrectly believe older people are too old to change.</p></li>
</ul>
<p>Older people may also be reluctant to seek help because of embarrassment, logistical problems (like a lack of transport), inappropriate treatment services for older people, or they do not know where to turn for help.</p>
<p>To combat these problems, we developed a <a href="https://www.peninsulahealth.org.au/wp-content/uploads/AODPenHealth_150915.pdf">free guide</a> to preventing and reducing alcohol and drug related harm among older people for health and welfare professionals.</p>
<h2>What needs to change</h2>
<p>Health-care services and the aged care sector need to work better together to prevent problem substance use among older people. They also need to provide age-appropriate treatment and harm minimisation services to people who need them. </p>
<p>Clinicians also need to better identify and treat alcohol, cannabis, and prescription drug misuse in their older patients.</p>
<p>Finally, we need more research into the best approaches for helping older people with substance use problems.</p>
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<p><em>If you would like to talk to a professional about your own or someone else’s alcohol or drug use, contact the free Alcohol and Drug Information Service in your <a href="http://www.drugs.health.gov.au/internet/drugs/publishing.nsf/content/CA12F53389330BD1CA2577EC007DEAFB/%24File/ADIS.pdf">state or territory</a>.</em></p><img src="https://counter.theconversation.com/content/82753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The National Centre for Education and Training on Addiction receives funding from the Commonwealth Department of Health.</span></em></p>More Australians over 50 are drinking and taking drugs than ever before. Here's why that can be a problem.Ann Roche, Professor and Director of the National Centre for Education and Training on Addiction, Flinders UniversityVictoria Kostadinov, Research officer, National Centre for Education and Training on Addiction, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/781402017-07-31T12:23:49Z2017-07-31T12:23:49ZHow sharing can make a hangover less harrowing<p>Headache and nausea aside, the morning after an evening of drinking can be filled with regret, anxiety and misery. But it can also be a time of humour, story-telling and emotional bonding.</p>
<p>This is what we found in a recent study examining the experiences of university students with hangovers. We asked them about their attitudes to being hungover – and the psychological and social effects on their lives. </p>
<p>Alcohol is a mood-altering drug. Intoxication can bring feelings of increased euphoria, relaxation and positivity, while reducing anxiety and tension. These effects are part of what makes alcohol one of the most widely consumed drugs in the world. </p>
<p>It is also a <a href="https://www.researchgate.net/profile/Harriet_Wit/publication/13405156_Individual_Differences_in_the_Biphasic_Effects_of_Ethanol/links/542337540cf26120b7a6be5b.pdf">“biphasic” drug</a>, which means it has two distinct phases of action. </p>
<p>The first, known as the “ascending limb” brings positive and euphoric mood as the concentration of blood alcohol increases. The second phase, the “descending limb”, occurs as blood alcohol concentration decreases and is generally accompanied by feelings of fatigue and low mood. </p>
<p>A small body of research has begun to study <a href="https://www.ncbi.nlm.nih.gov/pubmed/20712597">the effects of hangovers on mood and emotion</a>. In general, these studies indicate that <a href="https://academic.oup.com/alcalc/article/41/1/54/165609/ALCOHOL-HANGOVER-EFFECTS-ON-MEASURES-OF-AFFECT-THE">hangover is associated with decreased positive mood and increased anxiety</a>. </p>
<p>These findings have serious implications for those who may have hangovers while carrying out caring responsibilities – parents, nurses, doctors and teachers, for example. But studies so far have been limited by simply asking individuals about their mood using questionnaires. Research using animals has been able to examine in more detail how socialisation and engagement with others may be influenced by a hangover. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/14745301">A study of rodents</a> showed that 18 hours after alcohol intoxication, the social behaviour of rats is reduced. The experiment was also able to look at differences in social behaviour between rodents of different ages. The adolescent rats engaged in more social interaction when hungover compared to the adults rats. </p>
<p>This finding suggests that adolescent rats might be less sensitive to the effects of alcohol hangover on anxiety and sociability. <a href="http://www.bath.ac.uk/psychology/news/news_0131.html">In our work</a> researching young peoples’ experience of hangover and the relationship between hangover and drinking behaviour, along with our colleague <a href="http://www.ucl.ac.uk/iehc/research/behavioural-science-health/people/staff/Freeman">Maddie Freeman</a>, we found that young people had a similar kind of tolerance.</p>
<p>All of the students we interviewed at a university in south-west England mentioned the psychological impact of hangovers. They spoke of feeling low, irritable, angry, sad and lonely. </p>
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<p>But they also felt that reducing alcohol consumption was not an option for minimising the effects. Hangovers were expected – and even planned for in their day to day lives. These findings are consistent with the animal research, suggesting a lesser impact for the youthful. For younger adults, hangovers may not be a powerful disincentive to heavy drinking. </p>
<p>We also found that some students actually considered hangovers to have a positive role in promoting group socialising. Communal experiences of hangover were presented as beneficial – of suffering the symptoms “all together”. </p>
<h2>About last night</h2>
<p>Hangovers were viewed as a continuation of the socialising from the previous evening, which included reminiscing about drunken activities from the night before. Similar to the adolescent rats engaging in social behaviours such as play fighting while hungover, it appears that for younger drinkers a hangover is part of the social experience of drinking. </p>
<p>Universities have long been thought of as places where young people learn not just about their chosen academic subject, but also the effects of drinking alcohol. For many, having a hangover is part of the university experience.</p>
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<span class="caption">Misery loves take-aways.</span>
<span class="attribution"><span class="source">Samuel Antony Merry</span>, <span class="license">Author provided</span></span>
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<p>How it affects their actual studies, we cannot yet be sure. <a href="https://theconversation.com/why-you-should-be-wary-of-going-to-work-with-a-hangover-78139">Recent research</a> suggests that hangovers have a significant affect on how we carry out routine activities such as work and driving. On any given work day, <a href="http://www.ias.org.uk/uploads/pdf/Factsheets/Alcohol%20in%20the%20workplace%20factsheet%20March%202014.pdf">around 200,000 British workers</a> turn up to work hungover. </p>
<p>Nor is research into the social element of hangovers complete. Fittingly perhaps, the overall effects on mood and interaction are not yet clear – blurry, even. </p>
<p>For some, hangovers are a time of psychological discomfort, accompanied by low mood. For others, they are an enjoyable extension of social drinking – when it really does seem that misery loves company.</p><img src="https://counter.theconversation.com/content/78140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The morning after can be tough. But company sometimes eases the pain.Sally Adams, Lecturer in Health Psychology, University of BathChristine Griffin, Professor of Social Psychology, University of BathPaula Smith, Senior Lecturer in Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/782922017-07-25T15:13:04Z2017-07-25T15:13:04ZWhy the number of people with more than one chronic condition is rising in Africa<figure><img src="https://images.theconversation.com/files/177892/original/file-20170712-19675-kuyyv0.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=496&amp;fit=clip" /><figcaption><span class="caption">Scientists estimate that by 2020, non-communicable disease will account for almost 70% of the total disease burden.
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>More and more people around the world are getting sick with <a href="http://apps.who.int/iris/bitstream/10665/252275/1/9789241511650-eng.pdf">two or more health conditions at the same time</a>. For example, people are increasingly coping with two chronic non-infectious diseases, like hypertension and diabetes. Or they will have a chronic infectious disease like HIV and a chronic non-infectious disease like asthma. </p>
<p>The co-existing conditions could include <a href="https://www.ncbi.nlm.nih.gov/pubmed/26309916">diseases</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/17716051">disorders</a>, illnesses or other chronic health problems. The concept of having two or more chronic health conditions at the same time is called multimorbidity. </p>
<p>Traditionally, developed countries have a high prevalence of non-communicable diseases – like hypertension – and due to this, a high rate of multimorbidity. </p>
<p>Now the tables <a href="https://www.ncbi.nlm.nih.gov/pubmed/26268536">seem to be turning</a>. Due to the rise in the cases of non-communicable diseases in developing countries, there is an increasing emerging pattern of high levels of multimorbidity. This includes cases of hypertension which is now the most common <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848740/">co-morbid chronic non-communicable disease</a> in the world.</p>
<p>The prevalence of non-communicable diseases is increasing at an alarming rate. In 2000, non-communicable diseases accounted for only 56% of the total disease burden. Scientists estimate that by 2020, they will account for almost 70% of the <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-4-2">total disease burden</a> in developing countries.</p>
<p>The <a href="http://www.who.int/nmh/publications/ncd_report_full_en.pdf">increase</a> has been driven by urbanisation and changing dietary and behavioural patterns with people eating more processed food and sugar and exercising less. </p>
<p>But alongside this, many developing nations, especially in Africa, have the additional burden of chronic infectious diseases. </p>
<p>Non-communicable diseases and chronic communicable diseases co-occur, and the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26103981">risk factors</a>, such as alcohol and tobacco use, associated with them are often shared. This further increases the likelihood of multimorbidity. </p>
<p>In Africa, the concern is that populations who are already socially and economically vulnerable also face <a href="https://www.ncbi.nlm.nih.gov/pubmed/27423295">the highest risk of multimorbidity</a>. These include the elderly, people who have a lower socio-economic status and those who are not as educated. An intersectoral approach to address these vulnerable groups is needed. This remains challenging for developing health services in many African countries. </p>
<h2>Affecting the patient and the system</h2>
<p>The impact of multimorbidity is three-fold: it affects the patient, the health care provider and the health system as a whole. </p>
<p>Multimorbid patients have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/16411033">decreased quality of life</a> and tend to access health services <a href="https://www.ncbi.nlm.nih.gov/pubmed/21436204">more frequently</a>. This often results in loss of potential income. And it places an extraordinary financial and psychological burden on the patient. The psychological burden often manifests as depression with mental health conditions frequently being <a href="https://www.ncbi.nlm.nih.gov/pubmed/22579043">associated with multimorbidity</a>, which are often neglected or poorly managed. </p>
<p>More generally, the high self-management requirements and multiple drug prescriptions associated with multimorbidity can lead to poorer health outcomes for patients.</p>
<p>From the provider perspective, multimorbid patients are complex to treat. This can lead to <a href="http://www.sciencedirect.com/science/article/pii/S0895435612001424">increased workloads</a>. In addition, they need an in-depth understanding of multiple drug and disease interactions. With each additional comorbidity consultation, time and individual <a href="https://www.ncbi.nlm.nih.gov/pubmed/21436204">patient cost increase dramatically</a>. </p>
<p>But providers often find themselves in systems which are inadequately prepared to deal with this level of complexity due to their vertical nature. Vertical systems are based on the one disease model of care, which focuses on individual diseases, rather than holistic patient care. </p>
<p>Innovative models of integrated care are required to appropriately manage the multimorbid patient. This is a challenging task as integrated models need to be context specific. A “one size fits all” isn’t enough to address patients’ needs.</p>
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<h2>Tackling the problem</h2>
<p>To tackle the problem, solutions need to focus on what’s causing multimorbidity. This means that policymakers must look beyond the health sector – they must engage with multiple sectors. This is necessary as most risk factors relating to multimorbidity are driven by factors that lie outside the health care system. Risk factors such as obesity, alcohol use and smoking can all be influenced by policies outside the health sector. </p>
<p>In South Africa, a well known example of this has been the reduction of secondary smoking as a result of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938898/">a range of anti-smoking initiatives</a>. These included using the media to run campaigns warning about the health risks of smoking, to limiting smoking areas in the hospitality industries alongside the establishment of an excise tax on tobacco products. </p>
<p>More recently, to address the rising burden of diabetes and associated risk factors, South Africa has proposed a tax on sugar-sweetened beverages. A similar tax was successful in reducing the consumption of <a href="http://www.bmj.com/content/352/bmj.h6704.long">sugar-sweetened beverages in Mexico</a>.</p>
<p>One of the challenges in creating these policies lies in opposing powerful industry actors whose interests don’t lie with health issues, but with making profits. This requires advocacy from several key public health role players such as academics, civil society, and governmental departments. </p>
<h2>Next steps</h2>
<p>In Africa, multimorbidity will impose increasing strain on vulnerable people and already stretched health systems. </p>
<p>A structured collaborative approach is needed to manage the problem. This should include developing a good understanding of Africa’s unique patterns of multimorbidity, its causes, and focus on prevention.</p><img src="https://counter.theconversation.com/content/78292/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tolullah Oni receives funding from the National Research Foundation. </span></em></p><p class="fine-print"><em><span>Natacha Berkowitz receives funding from a Global Health Clinical Research Training Fellowship funded by Imperial Wellcome Trust Institutional Strategic Support Fund.</span></em></p>The increase in cases of non-communicable diseases in developing countries has led to an emerging pattern of high levels of multimorbidity.Tolullah Oni, Associate Professor at the School of Public Health and Family Medicine, University of Cape TownNatacha Berkowitz, Global Health Clinical Research Fellow Imperial College London and Honorary Research Officer, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.